[asa] Consciousness in the vegetative state?

There was an article of interest published yesterday in Science.

http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/4070

Using fMRI they were able to document activity in areas of the brain that was not expected. For example the areas of the brain that process verbal language were active when she was spoken too. And more interestingly, they were able to show activity in motor areas when they told the patient to imagine doing some physical activity, such as playing tennis, or walking through her house.

This is certainly of theoretical interest and raises questions about what consciousness is.

I do no think however it would have much impact on clinical medicine yet, and decisions about withdrawing treatment in patients in a persistent vegetative state. First this is only a report about a single case. In addition the person is young (23) and emerged from a coma after a motor vehicle accident (the time in vegetative state was not published in the reports I have seen) . Both of these factors (young age, and traumatic vegetative state) are favorable for recovery from a vegetative state. A person that is older, has been in a PVS for a long period of time (greater than 1 year), and whose PVS is a result of anoxic brain inury, very likely has a different condition altogether that the patient reported here, and I would suspect would not show similar responses.

Nevertheless, the decisions up to this point to withdraw treatment is based not on whether or not the person has retained consciousness, but is based on the surrogates assesment about whether or not the patient would want to continue living in such a condition, whether or not they were currently aware of their condition. If it could be clearly determined whether or not someone retains consciousness, and is in a condition from which they never would recover, this would have significant implications on this decision. In other words, if you were aware, but were going to be forever trapped in a body that prevented you from any interaction with the external world, would you want to continue living in that condition? It is something to think about.

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Received on Sat Sep 9 10:08:55 2006